1. No category

International Journal of Nursing Studies 52 (2015) 791–793
Contents lists available at ScienceDirect
International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns
Guest Editorial
On self-compassion and self-care in nursing: Selfish or essential
for compassionate care?
Keywords:
Caring
Compassion
Nurse
Nursing
Self-care
Self-compassion
Compassionate care in nursing is increasingly an
international concern. While the literature to date has
focussed on redressing a compassion and care deficit
across the nursing discipline (Crawford et al., 2014; Dewar
et al., 2014; Scott, 2014), we suggest here that due
consideration be given to its relationship to self-care and
self-compassion in nurses. After all, a deficit in these
compromises nurses’ therapeutic use of self in the
provision of compassionate care to patients. As a noted
scholar and practitioner of compassion, the Dalai Lama
(2003, p. 125) argues that:
For someone to develop genuine compassion towards
others, first he or she must have a basis upon which to
cultivate compassion, and that basis is the ability to
connect to one’s own feelings and to care for one’s own
welfare. . . Caring for others requires caring for oneself.
Compassion for others is surely a motivating factor for
most that join the nursing profession. Indeed it could be
argued that nursing care is synonymous with compassion.
However, the degree to which nurses balance this care by
extending compassion and care to themselves is given
little attention. While much has arisen from Orem’s selfcare deficit theory (Wilkinson and Whitehead, 2009), there
is a dearth of literature on self-care for nurses. Research on
compassionate care is building momentum, but to date
few studies have focused on nurses’ self-compassion.
Fewer still have considered its relationship to nurses’ selfcare and care for patients. We thus feel it is timely to
discuss a broader perspective on compassionate care;
valuing the primacy of self-compassion and self-care, to
support nurses’ compassionate care for patients.
http://dx.doi.org/10.1016/j.ijnurstu.2014.10.009
0020-7489/ß 2014 Elsevier Ltd. All rights reserved.
Two seemingly distinct crises are discussed in the
recent nursing literature – a global workforce crisis (Van
den Heede and Aiken, 2013) and the ‘crisis in nursing care’
(Darbyshire and McKenna, 2013). Clearly, it is shortsighted to view these in isolation.
Given that nurses’ wellbeing and quality of care have
been shown to be interdependent (Maben et al., 2012), it is
not surprising that compassionate care for patients has
become a pressing issue. The impacts of occupational stress,
burnout, and compassion fatigue feature prominently in the
literature (Chang et al., 2007; Lee et al., 2012; Tucker et al.,
2012); as does workforce turnover and nurse shortages
(Hayes et al., 2012; Roche et al., 2014). Many nurses cope by
distancing themselves from patients (Mackintosh, 2007).
Whilst this has implications for the therapeutic relationship,
of greater concern, is the dehumanisation of patients by a
profession that espouses humanistic care (Maben et al.,
2012; Trifiletti et
al., 2014). The nursing practice
environment is a key factor (Norman, 2013), but within
this environment nurses are, themselves, clearly in need of
self-compassion and self-care. Despite the centrality of
caring in nurses’ work, many nurses neglect self-care
(McAllister and McKinnon, 2009). Why is this so?
Richards (2013) asserts that self-care is vital and
benefits both nurses and patients. Many might argue
however, that for nurses, any emphasis on self per se, is
contrary to the compassionate care of others. Self-care
could be seen to foster a culture of selfishness throughout
the nursing profession. Indeed, some have labelled selfcare practice as ‘responsible selfishness’ (Adam and Taylor,
2013), but this serves only to perpetuate the existing
stigma of self-care as selfish (Rose and Glass, 2008). The
caring capacity of nurses, in a holistic sense, is questionable where nurses fail to care for themselves. Shapiro
(2008) highlighted metaphorically that the human heart
needs to first pump blood to itself. This is further supported
by Watson’s (2008) Theory of Human Caring, in which
nurses’ care for self and others is interdependent, rather
than mutually exclusive. By practising self-care nurses can
better embody their role as exemplars for health promotion (Blake and Harrison, 2013; McElligott et al., 2009). But
792
Editorial / International Journal of Nursing Studies 52 (2015) 791–793
problems arise from a tacit understanding within nursing
that the act of caring, for self or others, is dichotomous. This
dichotomy and the lack of research evidence supporting
self-care undermine the growing emphasis on holistic
nursing care (Rose and Glass, 2008). Greater recognition of
the importance of self-care is required.
Richards (2013) argues that the practice of self-care
should be a professional expectation inherent to the role of
nurses. This warrants consideration. The importance of
nurses’ self-care is evident in the International Council
of Nurses’ (ICN) competency standards for general registered nurses (Alexander and Runciman, 2003). However,
corresponding standards in individual countries do not
necessarily align with those of the ICN. In the UK for
example, the importance of self-care for nurses is not
evident in the Nursing and Midwifery Council’s (2010)
Standards for competence for registered nurses framework.
Nor is it evident in practice standards for registered nurses
in other countries such as New Zealand (Nursing Council of
New Zealand, 2007), Canada (The College of Nurses
Ontario, 2014), and the Philippines (Philippine Nurses
Association, 2012). The problem of neglecting self-care
for nurses within practice standards has also been
identified in Korea (Shin and Eschiti, 2005).
The workforce literature shows the importance of selfcare for all nurses, but these discrepancies suggest that this
is not recognised consistently. This raises implications for
the global development of nursing practice standards, or
revision of existing standards that lack self-care content.
While socio-political factors are likely to be influential in
each country, without decisive action to promote the
importance of self-care, it is likely to remain poorly visible
and undervalued in nursing. Maben (2008) identified that
the importance of nurses’ caring work, in general, is often
invisible and subordinated. Therefore, the imperative here
is to make the importance of self-care visible and more
valued in practice. It is questionable whether nurses will
practice self-care if they are not explicitly trained or
required to do so. But it is also uncertain whether the
inclusion of self-care in education and practice standards
would be effective, if nurses lack capacity to be kind to
themselves through self-compassion.
Neff (2003) pioneered research into self-compassion,
based on Buddhist psychology that considers compassion
for self as equally important to compassion for others. As
a construct, self-compassion was operationalised through
the development and validation of a scale to measure its
components of self-kindness, mindfulness, and common
humanity (Neff, 2003). According to Germer (2009, p. 33)
self-compassion is ‘‘simply giving the same kindness to
ourselves that we would give to others.’’ Comprehensive
studies have linked self-compassion with increased compassion for others (Jazaieri et al., 2013; Neff and Germer,
2013; Neff and Pommier, 2013), in addition to resilience and
emotional intelligence (Heffernan et al., 2010; Neff and
McGehee, 2010), and other pro-social behaviours (Neff et
al., 2007). Self-compassion has been found to be distinct
from, and not associated with, narcissism (Leary et al.,
2007). Moreover, randomised controlled trials have established that training interventions can increase compassion
and self-compassion in certain populations (Jazaieri et al.,
2013; Neff and Germer, 2013). But the vast majority of selfcompassion studies to date have originated from the
discipline of psychology and non-clinician populations.
Research into self-compassion has only recently begun to
appear in the health professional domain.
Of only three known studies to investigate selfcompassion in nurses, two demonstrated a positive
correlation with emotional intelligence in both nurses
and student nurses (Heffernan et al., 2010; S¸enyuva et al.,
2013); while the third explored clinical educators’
understanding of self-compassion as a source for compassionate care (Gustin and Wagner, 2013). There is emerging
evidence to suggest a relationship between nurses’ selfcompassion and compassionate care for patients. However, it is important to consider the organisational environment within which compassionate care is provided.
In a nursing context, compassion has been observed to
be subtle, and yet, distinctly palpable in its benefit to both
individuals and organisations (Frost, 1999). But to what
extent can nurses be expected to provide compassionate
care, if their workplaces are not compassionate? Dutton et
al. (2008, p. 110) argue that ‘‘as human institutions,
organisations are sites that inevitably harbour the
emotional pain and suffering of their individual members.’’
Therefore, compassionate leadership is vital. While some
emphasise compassion at an individual level within
organisations (Atkins and Parker, 2012), others underscore
the importance of shared responsibility and organisational
leadership (Scott, 2014; Straughair, 2012). Compassion is
central to the practice of leadership (Georges, 2011). The
primacy of compassion—for self and others—must be
engendered within, and not merely espoused by, healthcare organisations. To this end, Crawford et al. (2014)
highlight the need for management, policymakers and
professional bodies to foster organisational environments
conducive to compassion. Within these environments,
nurses can better embody the compassionate care that is
expected of nursing as a caring profession.
Self-care is not selfish. For the wellbeing and congruence of nurses—as educators and health promotion
advocates—it is essential. Similarly, self-compassion is
not narcissistic. Rather, it is a foundation for compassionate care. But further research is needed: firstly to examine
the influence of the relationship between self-compassion
and self-care in nurses; then to test its relationship to
compassionate care for patients. This emerging line of
inquiry in nursing practice can serve to progress the
imperative of compassionate care towards a compassion
that is more genuine.
Acknowledgement
The first author is supported by an Australian Postgraduate Award from The University of Sydney.
Conflict of interest: None declared.
References
Adam, D., Taylor, R., 2013. Compassionate care: Empowering students
through nurse education. Nurse Educ. Today 34 (9), 1242–1245,
http://dx.doi.org/10.1016/j.nedt.2013.07.011.
Editorial / International Journal of Nursing Studies 52 (2015) 791–793
Alexander, M.F., Runciman, P.J., 2003. ICN Framework of Competencies for
the Generalist Nurse. International Council of Nurses, Geneva,
Switzerland.
Atkins, P.W.B., Parker, S.K., 2012. Understanding individual compassion in
organisations: the role of appraisals and psychological flexibility.
Acad. Manage. Rev. 37 (4), 524–546, http://dx.doi.org/10.5465/
amr.2010.0490.
Blake, H., Harrison, C., 2013. Health behaviours and attitudes towards
being role models. Br. J. Nurs. 22 (2), 86–94.
Chang, E.M.L., Bidewell, J.W., Huntington, A.D., Daly, J., Johnson, A.,
Wilson, H., Lambert, V.A., Lambert, C.E., 2007. A survey of role stress,
coping and health in Australian and New Zealand hospital nurses. Int.
J. Nurs. Stud. 44 (8), 1354–1362, http://dx.doi.org/10.1016/j.ijnurstu.
2006.06.003.
Crawford, P., Brown, B., Kvangarsnes, M., Gilbert, P., 2014. The design of
compassionate care. J. Clin. Nurs., http://dx.doi.org/10.1111/jocn. 12632.
Dalai Lama, 2003. Transforming the Mind: Teachings on Generating
Compassion. Thorsons, Hammersmith, London.
Darbyshire, P., McKenna, L., 2013. Nursing’s crisis of care: what part does
nursing education own? Nurse Educ. Today 33 (4), 305–307, http://
dx.doi.org/10.1016/j.nedt.2013.03.002.
Dewar, B., Adamson, E., Smith, S., Surfleet, J., King, L., 2014. Clarifying
misconceptions about compassionate care. J. Adv. Nurs. 70 (8), 1738–
1747, http://dx.doi.org/10.1111/jan.12322.
Dutton, J., Lilius, J.M., Kanov, J., 2008. The transformative potential of
compassion at work. In: Piderit, S.K., Cooperrider, D.L., Fry, R.E. (Eds.),
Handbook of Transformative Cooperation: New Designs and Dynamics. Stanford University Press, Palo Alto, CA, pp. 107–126.
Frost, P.J., 1999. Why compassion counts! J. Manage. Inq. 8 (2), 127–133,
http://dx.doi.org/10.1177/105649269982004.
Georges, J.M., 2011. Evidence of the unspeakable: biopower, compassion,
and nursing. Adv. Nurs. Sci. 34 (2), 130–135, http://dx.doi.org/
10.1097/ANS.0b013e3182186cd8.
Germer, C.K., 2009. The Mindful Path to Self-Compassion. The Guilford
Press, New York, NY.
Gustin, L.W., Wagner, L., 2013. The butterfly effect of caring – clinical
nursing teachers’ understanding of self-compassion as a source to
compassionate care. Scand. J. Caring Sci. 27 (1), 175–183, http://
dx.doi.org/10.1111/j.1471-6712.2012.01033.x.
Hayes, L.J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F.,
Laschinger, H.K.S., North, N., 2012. Nurse turnover: A literature
review – An update. Int. J. Nurs. Stud. 49 (7), 887–905, http://
dx.doi.org/10.1016/j.ijnurstu.2011.10.001.
Heffernan, M., Griffin, M.T.Q., McNulty, S.R., Fitzpatrick, J.J., 2010. Selfcompassion and emotional intelligence in nurses. Int. J. Nurs. Pract. 16
(4), 366–373, http://dx.doi.org/10.1111/j.1440-172X.2010.01853.x.
Jazaieri, H., Jinpa, G., McGonigal, K., Rosenberg, E., Finkelstein, J., SimonThomas, E., Cullen, M., Doty, J., Gross, J., Goldin, P., 2013. Enhancing
compassion: a randomized controlled trial of a compassion cultivation
training program. J. Happiness Stud. 14 (4), 1113–1126, http://
dx.doi.org/10.1007/s10902-012-9373-z.
Leary, M.R., Tate, E.B., Adams, C., Allen, A.B., Hancock, J., 2007. Selfcompassion and reactions to unpleasant self-relevant events: the
implications of treating oneself kindly. J. Pers. Soc. Psychol. 92 (5),
887–904, http://dx.doi.org/10.1037/0022-3514.92.5.887.
Lee, M., Laurenson, M., Whitfield, C., 2012. Can compassion be taught to
lessen the effects of compassion fatigue? J. Care Serv. Manage. 6 (3),
121–130, http://dx.doi.org/10.1179/1750168713Y.0000000016.
Maben, J., 2008. The art of caring: Invisible and subordinated? A response
to Juliet Corbin: ‘Is caring a lost art in nursing?’. Int. J. Nurs. Stud. 45
(3), 335–338, http://dx.doi.org/10.1016/j.ijnurstu.2007.09.002.
Maben, J., Adams, M., Peccei, R., Murrells, T., Robert, G., 2012. ‘Poppets and
parcels’: the links between staff experience of work and acutely ill
older peoples’ experience of hospital care. Int. J. Older People Nurs. 7
(2), 83–94, http://dx.doi.org/10.1111/j. 1748-3743.2012.00326.x.
Mackintosh, C., 2007. Protecting the self: a descriptive qualitative exploration of how registered nurses cope with working in surgical areas.
Int. J. Nurs. Stud. 44 (6), 982–990, http://dx.doi.org/10.1016/j.ijnurstu.2006.04.009.
McAllister, M., McKinnon, J., 2009. The importance of teaching and
learning resilience in the health disciplines: a critical review of the
literature. Nurse Educ. Today 29 (4), 371–379, http://dx.doi.org/
10.1016/j.nedt.2008.10.011.
McElligott, D., Siemers, S., Thomas, L., Kohn, N., 2009. Health promotion in
nurses: is there a healthy nurse in the house? Appl. Nurs. Res. 22 (3),
211–215, http://dx.doi.org/10.1016/j.apnr.2007.07.005.
Neff, K., Pommier, E.A., 2013. The relationship between self-compassion and other-focused concern among college undergraduates,
community adults, and practicing meditators. Self Identity 12
(2), 160–176.
793
Neff, K.D., 2003. The development and validation of a scale to measure
self-compassion. Self Identity 2 (3), 223.
Neff, K.D., Germer, C.K., 2013. A pilot study and randomized controlled
trial of the mindful self-compassion program. J. Clin. Psychol. 69 (1),
28–44, http://dx.doi.org/10.1002/jclp.21923.
Neff, K.D., Kirkpatrick, K., Rude, S., 2007. Self-compassion and its link to
adaptive psychological functioning. J. Res. Personal. 41, 139–154.
Neff, K.D., McGehee, P., 2010. Self-compassion and psychological
resilience among adolescents and young adults. Self Identity 9,
225–240.
Norman, I., 2013. The nursing practice environment. Int. J. Nurs. Stud. 50,
1577–1579.
Nursing & Midwifery Council, 2010. Standards for Competence for Registered Nurses, http://www.nmc-uk.org/Documents/Standards/Standards%20for%20competence.pdf (accessed 15.09.14).
Nursing Council of New Zealand, 2007. Competencies for Registered
Nurses, http://www.nursingcouncil.org.nz/content/download/263/
1205/file/Competencies%20for%20registered%20nurses.pdf
(accessed 16.09.14).
Philippine Nurses Association, 2012. National Nursing Core Competency
Standards,
http://www.pna-ph.org/downloads/2012%20Core%20Competency%20Standards.pdf (accessed 16.09.14).
Richards, K., 2013. Self-care is a lifelong journey. Nurs. Econ. 31 (4),
198–202.
Roche, M.A., Duffield, C.M., Homer, C., Buchan, J., Dimitrelis, S., 2014. The
rate and cost of nurse turnover in Australia. Collegian, http://
dx.doi.org/10.1016/j.colegn.2014.05.002.
Rose, J., Glass, N., 2008. Enhancing emotional well-being through selfcare: the experiences of community health nurses in Australia. Holist.
Nurs. Pract. 22 (6), 336–347, http://dx.doi.org/10.1097/01.hnp.
0000339345.26500.62.
Scott, P.A., 2014. Lack of care in nursing: Is character the missing
ingredient? Int. J. Nurs. Stud. 51 (2), 177–180, http://dx.doi.org/
10.1016/j.ijnurstu.2013.08.006.
S¸enyuva, E., Kaya, H., Is¸ik, B., Bodur, G., 2013. Relationship between
self-compassion and emotional intelligence in nursing students.
Int. J. Nurs. Pract., http://dx.doi.org/10.1111/ijn.12204.
Shapiro, S.L., 2008. The Art and Science of Meditation. R. Cassidy Seminars,
Skirball Cultural Center, Los Angeles, CA.
Shin, S.R., Eschiti, V.S., 2005. East meets west: a search for holism in
Korean nursing practice. J. Holist. Nurs. 23 (3), 356–362, http://
dx.doi.org/10.1177/0898010105277653.
Straughair, C., 2012. Exploring compassion: implications for contemporary nursing. Part 2. Br. J. Nurs. 21 (4), 239–244.
The College of Nurses Ontario, 2014. Competencies for Entry-level Registered Nurse Practice, http://www.cno.org/Global/docs/reg/41037_
EntryToPracitic_final.pdf (accessed 16.09.14).
Trifiletti, E., Di Bernardo, G.A., Falvo, R., Capozza, D., 2014. Patients are not
fully human: a nurse’s coping response to stress. J. Appl. Soc. Psychol.,
http://dx.doi.org/10.1111/jasp.12267.
Tucker, S.J., Weymiller, A.J., Cutshall, S.M., Rhudy, L.M., Lohse, C.M., 2012.
Stress ratings and health promotion practices among RNs: a case for
action. J. Nurs. Adm. 42 (5), 282–292.
Van den Heede, K., Aiken, L.H., 2013. Nursing workforce a global priority
area for health policy and health services research: a special issue. Int.
J. Nurs. Stud. 50 (2), 141–142, http://dx.doi.org/10.1016/j.ijnurstu.
2012.04.015.
Watson, J., 2008. Nursing: The Philosophy and Science of Caring. University Press of Colorado, Boulder, CO.
Wilkinson, A., Whitehead, L., 2009. Evolution of the concept of self-care
and implications for nurses: a literature review. Int. J. Nurs. Stud. 46
(8), 1143–1147, http://dx.doi.org/10.1016/j.ijnurstu.2008.12.011.
Jason Mills*
Timothy Wand
Jennifer A. Fraser
Sydney Nursing School,
The University of Sydney, New South Wales 2050, Australia
*Corresponding author at: Sydney Nursing School,
The University of Sydney, Camperdown, New South Wales
2050, Australia. Tel.: +61 2 408 587 577
E-mail address: [email protected]
Received 9 October 2014